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Introduction to Acute Renal Failure

- Acute renal failure (ARF), also known as acute kidney injury (AKI), is a sudden loss of kidney function due to damage or dysfunction of the kidneys.

- It can affect anyone, but it is more common in hospitalized patients, especially those in critical care units.

- Acute renal failure is defined as a rapid decline in glomerular filtration rate (GFR), which is the rate at which the kidneys filter blood and remove waste products.

- GFR is measured by serum creatinine, which is a waste product of muscle metabolism. A normal GFR is about 90 to 120 mL/min/1.73 m2.

- ARF is diagnosed when there is an increase in serum creatinine of 0.3 mg/dL or more within 48 hours, or a decrease in urine output of less than 0.5 mL/kg/hour for 6 hours or more.

- ARF can be classified into three categories, depending on the site of the problem:

  • Prerenal ARF: This occurs when there is reduced blood flow to the kidneys, resulting in decreased GFR. This can be caused by conditions such as dehydration, hypovolemia, heart failure, shock, sepsis, or renal artery stenosis.
  • Intrinsic ARF: This occurs when there is damage to the kidney tissue itself, resulting in impaired filtration and tubular function. This can be caused by conditions such as acute tubular necrosis (ATN), acute interstitial nephritis (AIN), glomerulonephritis, vasculitis, or contrast-induced nephropathy.
  • Postrenal ARF: This occurs when there is an obstruction to the urine flow from the kidneys, resulting in increased pressure and backflow of urine into the kidney. This can be caused by conditions such as kidney stones, benign prostatic hyperplasia (BPH), tumors, blood clots, or neurogenic bladder.

Questions on Introduction to Acute Renal Failure

Correct Answer is C

Explanation

Incorrect. While the statement is partially true, it does not capture the acute and sudden nature of acute renal failure. The inability of the kidneys to filter waste products from the blood is one of the manifestations of AKI.

Correct Answer is B

Explanation

Incorrect. High blood sugar levels and frequent urination are not directly related to acute renal failure. These symptoms are more characteristic of diabetes mellitus.

Correct Answer is A

Explanation

Incorrect. Seasonal allergies are not associated with an increased risk of acute renal failure.

Correct Answer is C

Explanation

Incorrect. Hypoactive bowel sounds and constipation are not directly related to fluid overload in acute renal failure.

Correct Answer is B

Explanation

Incorrect. Fluid restriction is not typically recommended in acute renal failure, especially if the client is experiencing fluid depletion and dehydration.

Correct Answer is D

Explanation

Correct. Loop diuretics are prescribed in acute renal failure to increase urine output and promote fluid excretion. This helps reduce fluid overload and decrease edema.

Correct Answer is A

Explanation

Incorrect. Promoting shallow breathing to retain carbon dioxide is not a recommended intervention for correcting metabolic acidosis. Respiratory acidosis and metabolic acidosis are different types of acid-base imbalances with distinct causes and treatments.

Correct Answer is B

Explanation

Incorrect. Preventing infection and complications is important, but it is not the priority over assessing kidney function in acute renal failure.QUESTIONS

Correct Answer is C

Explanation

Incorrect. While UTIs and kidney stones can cause kidney injury, they are not the exclusive causes of acute renal failure, which can have various underlying etiologies.

Correct Answer is A

Explanation

Incorrect. Diabetes mellitus is a risk factor for chronic kidney disease, but it is not a specific risk factor for prerenal acute renal failure.

Correct Answer is B

Explanation

Incorrect. Urinary tract obstruction is also associated with postrenal acute renal failure, not intrinsic causes.

Correct Answer is A

Explanation

Incorrect. While ciprofloxacin and other antibiotics may have renal-related side effects, they are not a common cause of intrinsic acute renal failure.

Correct Answer is C

Explanation

Incorrect. Chronic kidney disease (CKD. is a risk factor for intrinsic acute renal failure, not postrenal.

Correct Answer is A

Explanation

Incorrect. While anemia can be associated with chronic kidney disease, it is not a specific risk factor for acute renal failure.

Correct Answer is A

Explanation

Incorrect. Thiazide diuretics may cause electrolyte imbalances and metabolic disturbances, but they are not a common cause of prerenal acute renal failure.QUESTIONS

Correct Answer is C

Explanation

Incorrect. Excessive fluid intake may contribute to fluid overload and decreased urine output in prerenal acute renal failure, but it is not the primary pathophysiological process that leads to decreased urine output.

Correct Answer is B

Explanation

Incorrect. Increased respiratory rate and depth are not typically associated with acute renal failure or its fluid and electrolyte imbalances.

Correct Answer is C

Explanation

Incorrect. Elevated creatinine levels can be seen in both acute and chronic kidney diseases, but they are not exclusively seen in chronic kidney disease.

Correct Answer is B

Explanation

Incorrect. Warm, flushed skin and headache are not directly related to metabolic acidosis.

Correct Answer is C

Explanation

Incorrect. Excessive thirst and dry mucous membranes are not specific to hyperkalemia and are not the most critical indicators of severe hyperkalemia.

Correct Answer is C

Explanation

Incorrect. Decreased respiratory rate and shallow breathing are not directly associated with uremia.

Correct Answer is C

Explanation

Incorrect. Excessive fluid intake and fluid overload may contribute to fluid retention and edema in prerenal acute renal failure, but they are not the primary pathophysiological process in acute renal failure.

Incorrect. Increased respiratory rate and shallow breathing are not typical respiratory manifestations of acute renal failure.QUESTIONS

Incorrect. Renal ultrasound is an imaging test that provides information about the structure of the kidneys but does not directly measure GFR.

Incorrect. While a renal ultrasound can visualize the blood vessels in the kidneys, its primary purpose is to assess kidney structure, not blood flow.

Incorrect. While a renal biopsy can provide information about the kidney's structure, its primary purpose is to obtain a tissue sample for histological examination, not to assess blood flow.

Incorrect. Removing jewelry and metallic objects is a standard precaution for all imaging procedures, but it is not specific to a CT scan with contrast dye.

Correct. Before an MRI scan, clients need to remove all metal objects and devices, including jewelry, piercings, hearing aids, and certain medical implants. Metal can interfere with the MRI's magnetic field and cause safety concerns during the procedure.

Correct. A renal nuclear scan, also known as a renal scintigraphy, involves injecting a small amount of radioactive material intravenously. The radioactive material is taken up by the kidneys, and the scan creates images that assess kidney function and blood flow.QUESTIONS

Correct. The nurse's best response is to encourage the client to follow their healthcare provider's instructions and avoid medications that may harm the kidneys. Compliance with prescribed treatment plans and avoiding nephrotoxic medications are essential to support kidney function and prevent furth

Incorrect. The description provided refers to the insertion of a urinary catheter for bladder drainage, not hemodialysis.

Incorrect. The cost of CRRT and intermittent hemodialysis can vary based on the healthcare setting and the client's needs. The cost-effectiveness depends on individual factors and resource availability.

Incorrect. Increasing the dwell time would not address the issue of cloudy dialysis fluid and potential infection.

Incorrect. Increasing the client'sfluid intake is not appropriate during a hypotensive episode, as it may not rapidly improve blood pressure and could lead to fluid overload.

Incorrect. The timing of loop diuretic administration is determined by the healthcare provider's order and the client's specific needs. Taking diuretics at bedtime may result in increased nighttime urination and sleep disruption.QUESTIONS

Incorrect. Encouraging the client to drink water freely would exacerbate fluid overload and impair the body's ability to eliminate excess fluids.

Incorrect. Chicken and fish are sources of protein and do not have high potassium content that would require restriction in most cases.

Incorrect. Adhesive tape can cause skin irritation and damage when removed, especially in clients at risk for impaired skin integrity.

Incorrect. Deep breathing exercises are not specific interventions for correcting metabolic acidosis.

Incorrect. Administering pain medication before passive range-of-motion exercises is not a standard practice and does not directly prevent complications of immobility.

Correct. Fresh fruits and vegetables are generally low in phosphate and are suitable for a low-phosphate diet. These foods can help meet the client's nutritional needs while adhering to the dietary restriction.

Incorrect. Gentle stretching exercises may not be appropriate for a client experiencing muscle cramps, as stretching could exacerbate the discomfort.

Incorrect. Antihypertensive agents are prescribed to manage hypertension and do not treat anemia in clients with renal failure.QUESTIONS
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